BSN's deliver safer care than ADN's??

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Now, I am all for further education, but I think this study is skewed. I truly don't see how they have come to the conclusion that taking more courses in the humanities and other such non-nursing related courses is going to produce a more competent bedside nurse. The core nursing cirriculum for most ADN and BSN programs is quite similar in my experience. I can see where the BSN nurse may have it over the ADN in managerial type roles, but as a bedside nurse? I think lots more studies need to be done before this quick conclusion is drawn. One factor that may affect nursing in this negative way is the poor economy. Maybe it is that some people are going into nursing just because it will almost guarantee them employment and don't really want to be in nursing and therefore are not as dedicated as nurses? These people may not want to go for the BSN. I don't know...that is just something I am throwing out there because this makes no sense to me. I don't want to start the old BSN vs. ADN war, but this is news and I was wondering, what do you all think?

http://www.upi.com/view.cfm?StoryID=20030923-050052-9024r

WASHINGTON, Sept. 23 (UPI) -- The ongoing nursing shortage in the United States has forced some hospitals to rely on nurses with less than a college education as they scramble to fill vacancies but new research suggests the practice can yield deadly consequences for patients.

The study, the first of its kind, reveals patients undergoing surgeries at hospitals where a greater proportion of nurses have obtained a bachelor's or higher degree experienced a lower rate of death than patients at hospitals where most nurses had only associate degrees.

Such findings have implications not only for patients but also for how nursing schools, hospitals and even the U.S. Congress should address the nursing shortage, Linda Aiken, a nurse and lead investigator of the study, told United Press International.

These institutions have made efforts to address the nursing shortage by facilitating the rapid training of nurses via associate degree programs, but the study indicates in the long-run the strategy might be worse for both patients and hospitals, said Aiken, who is director of the center for health outcomes and policy research at the University of Pennsylvania's School of Nursing in Philadelphia.

It underscores the need to find ways to increase the numbers of nurses graduating from bachelor degree programs, she said, noting some hospitals studied did not employ a single nurse with a bachelor's or higher degree.

In the study, which is published in the Sept. 24 issue of the Journal of the American Medical Association, Aiken's team examined patient data from 168 Pennsylvania hospitals over a 19-month period beginning in 1998. They found, all other factors being equal, hospitals where 60 percent of the nurses held a bachelor's degree or higher had a 19-percent lower rate of surgical patients dying within 30 days of admission or dying from complications than hospitals where only 20 percent of nurses had higher degrees.

The authors estimate if all the hospitals in the study could meet the 60-percent, bachelor's-degree-or-higher threshold, 725 patient deaths could have been prevented over the study period.

The differences in patient mortality rates "are stunning and should make people very concerned," Geraldine Bednash, a registered nurse and executive director of the American Association of Colleges of Nursing, told UPI. "One of the first questions (patients) ought to ask people in a hospital is what is the proportion of their nurses with bachelor's degrees, and if it's not 60 percent or higher, I'd be very concerned about going into that hospital," Bednash said.

The higher rate of patient deaths associated with lower education level is compounded by the fact that "all of the federal government's projections about the nursing shortage over the past decade have not only projected a shortage of nurses but a severe shortage of baccalaureate degreed nurses," Aiken said. At present, less than half of all hospital staff nurses across the nation hold bachelor's degrees or higher.

"Policymakers seem to think we just need to get nurses out fast," but that is not good for hospitals or patients, Bednash said, suggesting legislators should focus on developing ways to produce more nurses with bachelor degrees because "it makes a difference in people's care and whether or not they live or die."

President George W. Bush signed the Nurse Reinvestment Act into law in 2002 in an effort to remedy the nursing shortage and Congress will likely authorize no more than $163 million for fiscal year 2004. But this falls far short of the $250 million the American Association of Colleges of Nursing estimated would be needed to address the problem.

"To date, we've had mostly a symbolic response from Congress," Aiken said, noting the money the legislative body has appropriated is "not a sufficient amount to close the nursing shortage."

Hospitals also have a role to play in addressing the problem, however, Aiken continued. They should "subsidize continued education to the nurses because there is a return to the hospital in terms of greater productivity and better patient outcomes," she said. But many hospitals do not seem to recognize the value of more education in their nurse because many have discontinued tuition reimbursement programs to help their nurses obtain bachelor's or advanced degrees, she said.

Aiken also noted the study found nursing experience was not associated with lower mortality rates of patients. "It's the educational level that's important and experience alone cannot achieve the same level of benefit for the patient as education plus experience," she said.

Joan Hrubetz, dean of the school of nursing at Saint Louis University, said as medical treatments become even more sophisticated, hospitals "will need nurses with advanced education to be able to deal with the kinds of treatments and diagnostics" that likely would be developed in the era of genetics and molecular-based medicine. "I don't think there's any question we need better trained nurses," Hrubetz told UPI.

Nevertheless, hospitals appear to be reluctant to make any changes based on this single study.

"Hospitals are very interested in studies such as this ... but it really needs to have further studies done because this really only represents one state," Rita Turley, president of the American Organization of Nurse Executives -- a subsidiary of the American Hospital Association -- told UPI.

The good news is although enrollment rates in baccalaureate nursing programs had been down over the past decade, they now appear to be on the rise. In addition, many schools are offering rapid training programs, in which holders of bachelor degrees in other fields can obtain a bachelor's degree in nursing in approximately one year, which may help increase the number of people joining the nursing profession.

Originally posted by shodobe

stevierae, I couldn't have said it any better. The only, ONLY thing I am pasionate about is my wife! Well my dogs also, but she knows that. Good, good post! Mike

Oh, gosh , Mike, and here I thought you were a professional bachelor!

I am passionate about animals--my own, as well as any and all others--my goal for this year is to volunteer at least once a week at the humane society and also "foster"some mama cats with their litters, so that they can bond with people and won't be feral-but it will be so hard to give them up once we have all bonded!!

Oh, and of course there's friend husband--but he knows that---

If ASN nurses take and pass the nclex then obviously they have the knowledge to practice. If the entry level is changed to BSN are they going to change the NCLEX to include mgmt related questions and GER questions?

I am with Stevierae as far as education goes..do CEUs, take additional specialty classes..that is far more valuable then an assoc nurse going back to get the BSN as far as having actual useable knowledge goes. If an RN wants to go the mgmt route or the Masters route then I can understand the pressing need to get the BSN.... If you start out in a BSN..great...but BSNs truly are not any better equipped to be nurses and practice than Assoc nurses. How to gain respect from your peers and the MDs is by having and applying knowledge over and above the basics. This knowledge can only be learned by exp and speciality classes..if they wanted to make us all experts we would go to school as long or longer than an MD....JMO Erin

i honestly DO understand what you are saying about asn/bsn not mattering in providing care but we just have to agree to disagree. i think improving and streamlining the educational preparation will put nurses on par with the other health professsionals that they work with daily. This is important for communication and respect in the workplace. When i worked in the public school system i noticed the difference in respect that teachers gave the other university prepared professionals in the building and the nurse. (the nurse was a bsn but everyone assumed she went to community college) THe Physical Therapist was treated like a doctor and speech pathologist was treated as an expert. When it came to medical and nursing decisions though, the nurse was second guessed at every turn,:rolleyes: I noticed the camaraderie between the others and how they all talked about their alma maters. It was clear to me that even though the nurse was "liked", the other professionals in the building did not treat her the way they treated others with similar educational backgrounds. This was not right but its the way it was. This is a PRIME reason why i feel that to be respected fully by other professional fields nursing should advance their educational level. People understand how hard education is and respect those who have attained a higher degree. I think upping the educational requirements for other professions has been a positive thing so why can't that be done for nursing? No you may not techincally "need" more education at this point to do your job but do you really think that pharmacology has underwent some massive change in the past 5 years to require pharmacy to go from bs prepared to the doctorate? are there some new exercises or philosophy to range of motion that PT's teach that require a sudden jump from bs to ms? Probably not but the leaders in those fields (and others) saw the need to increase educational standards for a reason. I think that reason includes bringing prestige, interest and increased revenue to their profession. I feel that nursing should do the same. For me it's not about WHO's better but about WHAT's best. of course everyone is entitled to their own opinion.

Specializes in Nursing Education.

I have to agree with smkoepke .... we (nursing) simply has to keep pace with emerging technologies and advancements in health care. If the rules for entry-level were to change today, people who did not hold the educational requirement, but held the RN license would be grandfathered and still allowed to practice.

This thread has been a wonderful discussion from many different perspectives. I am not sure why nurses, who hold RN licensure, are opposed to establishing a new entryl-level. It would not affect you. The people that it would impact are those people who desire to become nurses. I know for me, I desire to hold a professional degree (one day I might finish school and have a BSN .... it will be a miracle for me, but it is something I want to have). For those nurses that hold the ADN or ASN degree, there would be no pressure for you to get a higher level degree unless you decided you wanted to go into management, teach or become an advanced practice nurse. So what is all the fuss about?

I have a very dear friend that is a Pharmacist. When her profession changed the educational requirements to become a Pharmacist from a Bachelor's degree to a Pharm D. .... she was all for it. Many of her friends who were Pharmacists were also supportive of the change. She held a Bachelor's degree and she said she would not go back to school because she felt her degree was fine for what she was doing. Fast forward to day ... she is about to graduate with her Pharm D. Why? Because after some reasonable thought, she felt the additional education would help her do her job.

I have posted many times to this thread and have to say that if we ever hope to have true collaboration with physicians and other health care professionals, we need to raise our educational standards. While increasing the educational standards to become an RN is not a magic pill that will make nursing's woes all better, it is a start for our profession.

I have often marveled at nursing history for the both the RN and LPN practice. I am amazed at how nursing has evolved over the years and how educational standards have in deed changed to produce a more well-rounded and educated nurse. Why should evolving educational standards for nurses stop now? We (as a profession) are on the threshold of some of the most impressive changes in health care. As new people enter our field, I submit that they need a longer duration of education in order to meet the needs of the patient. Experienced nurses, whether you have the ADN, BSN or MSN, you are experienced and worked in the trenches. You know the ropes, you have the inside edge and experience to provide great care. New people entering nursing need more training, more education to do the best they can for the patient.

Really, what is comes down to is what expectations do we have for the next generations of nurses? We are the ones that need to set the course for a better profession. Does the degree do that? Perhaps not, but as I said before, it is a start and maybe, it will unify us once and for all and take away any doubt that nursing is a true profession and not a vocation.

Patrick

patrick you said it better than i could. thanks:kiss

Maybe I missed this but my question is did the article say anything about the other degrees that ADNs had. I myself already have a BS in Child Development. I didnt read anywhere( I dont think) that the ADNs of the study didn't have any other degrees. It is my understanding, at least around here, that we have educationand decided for a change. Now from what my instructors are telling me having a BS and now working on my ADN will open more doors for me in the future. So would you say that I am on a level with a BSN because of that education.Ive been told that BSNs and ADNs here are on the same level and the only defining factor is who taught you. BUt I also think what does it matter because every nurse in the hospital here only have RN on their nametag, no MSN or BSN or ADN. We need to stick together and say that we all take the same test and we do the same work so just drop it.

I have a Masters degree in Social Work and an Associate degree in nursing. I make twice as much as a staff nurse then I did as a discharge planner! I've noticed the Docs could care less if you're a 2,3,4 year grad...they just want a competent, EXPERIENCED nurse with good assessment and critical thinking skills. 90% is learned on-the-job and takes years to perfect. Although, I absolutely believe any nurse who holds a higher educational degree should be compensated for it.

Specializes in Nursing Education.
Originally posted by smkoepke

patrick you said it better than i could. thanks:kiss

Thank you.

I think the study is of questionable validity, depending on whether it looked only at ADN vs BSN or if it also looked at other degrees held by the subjects (as someone pointed out, they may have started with ADN and progressed to BSN, or they may be ADN who hold other types of degrees than nursing).

Personally, I think both the ADN and BSN prepare you to become a good bedside clinician. Where you go from there is up to you- advanced certification, advanced degrees, or whatever.

Education is always a good thing, and furthering your education can only benefit you as a person. You learn new ways of thinking about things and looking at things. You extend your knowledge base beyond what you learned initially. Yup, you learn to write some darn good papers too! :)

Does this make you a better bedside clinician? Maybe, maybe not. Does this enhance your ability to think critically, and communicate ideas? Probably.

This doesn't mean you didn't have the ability to think critically and communicate before you got the degree, it's just an enhancement of the skills you already learned.

If you plan to go into research, teaching, or advanced practice, obviously you're going to need some education beyond the basic level, in order to function appropriately in those roles.

It's all good- relax.

Originally posted by snrubel

This is my first post to the board after lurking for some time... As a person with a graduate degree in another field I note the nature of this debate is part of the problem.

The bottom line is this: Until nursing recognizes the BSN as the entry-level education for practice then nursing will not be as respected as it should be by other health professionals. Sorry, but that's the truth. Education = respect in the medical field as someone else has already pointed out. Associate's degree recipients are never going to be given autonomy and be considered peers by those with Master and Doctoral preparation. People with Master's and Doctoral level preparation realize the importance of education and will, well, scoff at those who think that education is not important.

It seems obvious that those with ADN and diploma school preparation feel strongly that they have plenty of education to function well in their jobs. In many circumstances this may be true. In general, however, thinking that you have plenty of education is a sure sign that you do not. The longer you continue your education and the more you learn the more you realize that you do NOT know as much as you initially thought.

BSN programs require more than just additional prerequisites -- they also require more nursing classes. And both are important. Don't discount the importance of the prerequisites; western civilization and other such things too. Mental development, analytical thought, and logical decision making is honed by continued learning generally, and not just in specific clinical classes. How about we start training nurses in 10th grade and then let them out to work a couple of years later? Because it won't work. Continued learning, emotional maturity, and a host of other factors are affected by age, education, experience, etc.

Certainly there will be many very intelligent ADNs and a subset of these will outperform their BSN, or even MSN, peers. But this will be the exception rather than the rule and will get worse with the continuing evolution and growing complexity of medicine.

It appears to me that not many of the people with highly emotional responses to this study are equipped with the statistics and research background to conclude whether this study is bunk or not. My personal opinion is that further studies will conclude that there is a statistical trend. At what point would you conclude that no more education will contribute to more favorable outcomes? Is 2 years of education the magic number? Unlikely.

I would like to make clear that I am not "bashing" ADNs or diploma school nurses; I am simply pointing out what many others, including most of the nursing associations, have already pointed out: until the BSN is viewed differently than other RNs, nursing will not make substantial progress as a profession.

You are 110% correct. The bottom line is the only reason the laws haven't changed to require a BSN as entry-level education to become an RN is because there is a shortage!!!! You can believe it or not, but if and when this shortage ever ends, you will be faced with this reality. This is something that the powers that be have been wanting to do for a long time, but they know they would only be biting their nose to spite their face to put this in effect now when they are in desperate needs of nurses. So for now, diploma and ADN programs will continue, but don't get too comfortable believing that they are here to stay. This has nothing whatsoever to do with an RN's capability as a bedside nurse because anyone with common sense knows that there are some great RN's with an ADNs and some great ones with BSNs just like there are lousy ones with both. The fact remains is regardless of how much we know that being a excellent bedside nurse has little to do with what program you choose, the rest of the world views education as the standard for professionalism, this my friends, like it or not, is a fact.

Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.
Originally posted by njstudentnurse

. So for now, diploma and ADN programs will continue, but don't get too comfortable believing that they are here to stay. .

OH I am quite comfortable that ADN's will NOT disappear for a LONG time, seeing as 60% of currently practicing RN's hold this level degree and a great many have NO intention of going further. I would not be TOO awful sure if I were YOU. It's all in what is available out there....too man people have NO access to BSN programs; too many others dont' want to spend that much money in a 4 year university to enter nursing. The shortage is not disappearing anytime too soon, either, unless the USA managed to rob the rest of the world of it's precious nursing pool. I would be MUCH more sure of THIS happening than I would the nursing field becoming all-BSN entry in the near future.

Originally posted by SmilingBluEyes

OH I am quite comfortable that ADN's will NOT disappear for a LONG time, seeing as 60% of currently practicing RN's hold this level degree and a great many have NO intention of going further. I would not be TOO awful sure if I were YOU. It's all in what is available out there....too man people have NO access to BSN programs; too many others dont' want to spend that much money in a 4 year university to enter nursing. The shortage is not disappearing anytime too soon, either, unless the USA managed to rob the rest of the world of it's precious nursing pool. I would be MUCH more sure of THIS happening than I would the nursing field becoming all-BSN entry in the near future.

That is why I said If and when.....no one knows when the shortage will end. I'm also sure that it won't be a all-BSN entry in the NEAR future, but like I said before, I wouldn't get TOO comfortable believing it is going to be like this forever. Only time will tell, I'm sure we'll find out before I retire in 35 years.

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